8:15 AM, the 3 minutes I spend before heading to the ward ─ A day in the life of a rehabilitation pharmacist mom

7:30 AM

My 4-year-old daughter presses her cheek against the hem of my clothes.

"Mommy, is it time for work already?"

As I answer yes,
half of my mind is already somewhere else.

The prescription change for the patient in their 90s I was in charge of yesterday evening.
I wonder if they were able to sleep well last night.

The hand stroking my daughter's head,
and the mind recalling the medical chart screen.
Even though they both belong to me,
I'm probably using different muscles.

──Doesn't your morning also
feel divided between home and work like this?

I leave the house just after 7:00.
When I sit in the car seat and fasten my seatbelt,
I switch from "mom" to "pharmacist."

To be precise, I start the run-up to make the switch.

8:00 AM

Convalescent rehabilitation ward.
I always head up to the ward at 8:15.
15 minutes before that—in other words, 8:00 AM.
Between the locker room and the ward's medical chart terminal,
there is a "3-minute" window that no one sees.

Changing into my white coat in the locker room,
picking up my PHS,
and getting on the elevator.

The approximately 3 minutes before I sit down at the medical chart terminal.
I always do three things during that time.

First

Reorganizing the instruction changes that came in since yesterday evening in my head.

"Did that person use the PRN risperidone at night?"
"How was their blood pressure during rehab time?"

Before opening the night shift nursing records,
I form my own hypothesis.
This is to compress the time for checking the answers into those 3 minutes.

Second

Roughly predicting who will be talking to whom on the ward today.

The internal medicine doctor makes rounds at 10:00 AM.
The physical therapist returns from the rehab room at 11:00 AM.
There is a conference at 2:00 PM.

Who is likely to bring up a medication-related topic,
and at what timing?

If I anticipate this in the morning, I get fewer surprises.

When a colleague from another profession asks, "HONO-san, about this..."
whether I can answer in 3 seconds or if it takes 3 minutes,
that difference is quite significant.

Third point

Recalling the patients who "caught my attention" yesterday.

The small sense of unease that I couldn't leave in the medical record.

"I feel like the constipation has been continuing for a while."
"I feel like the blood pressure during walking was a bit low."

I place these things, which might just end up being my imagination,
back into my mind once more.
─I think a pharmacist's prescription proposal
probably starts from this "I feel like..."

When the 3 minutes are up,
I sit at the ward's medical record terminal.
I'm not doing anything special.
I'm just doing a warm-up that no one else sees.

Even so, on days when I don't have these 3 minutes,
I feel like I'm somehow on the back foot all day long.

Once I head up to the ward, the flow of the day is set.

10:00 AM

A nurse
calls out to me while pushing the medication cart.

"HONO-san, the patient in Room 3 seemed a bit sleepy this morning."

Please wait a moment,
I say in my heart,
as I open the medical record.

What was their nighttime sleep medication again?
Brotizolam, or was it Lemborexant?

──Honestly, I can't remember it immediately on the spot.

No matter how many years I've been doing this,
all the prescriptions for every single patient
don't just pop into my head.

I look at the charts, check the night shift records, and
finally, I can form a hypothesis.

"The sleeping medication at night might be a bit too strong. I'll check on the patient again before rehab and consult with the doctor."

It's a conversation that doesn't end in 30 seconds.
But since I had thought about it a little in the morning, maybe it went a bit more smoothly.

11:00 AM

I pass the physical therapist returning from the rehab room
in the hallway.

"That patient's blood pressure was a bit low during rehab today."

Even though the patient's face comes to mind,
I can't remember if this morning's antihypertensive was Amlodipine
or Telmisartan.
That's just how it is.

"Thank you, I'll review the evening prescription."

With a three-step chat, one more task is added to my afternoon.

2:00 PM

Before the conference, the registered dietitian approaches me with some documents.

"This patient's phosphorus levels are rising; could it be related to their medication?"

The moment you get asked a question,
isn't it usually a surprise?

Phosphate binders, gastrointestinal drugs, diuretics—

Several "areas to check" pop into my head, but the answer doesn't come out immediately.

"There seem to be a few possibilities.
I'll organize them and bring them to the conference."

—When I line it all up,
it seems pharmacists do quite a lot of work just chatting in the hallways.

And I haven't been able to answer anything on the spot...

But I think that taking things back to look into without being embarrassed about "not being able to answer immediately" is also an important part of the job.

5:00 PM

It is time to look back once more
at the conversations I had that day.

I consulted with the doctor and reduced the dose of the sleeping medication
for the patient who looked sleepy this morning by half.

I hope that tomorrow morning,
they will find it a little easier to wake up.

Looking back on the day, I suddenly think this:
I am checking the answers
to the hypotheses I formed during those 3 minutes in the morning.

──A pharmacist's day is probably just this cycle repeated.

Predicting in the morning,
being spoken to during the day,
and verifying in the evening.

Most days have no flashy prescription proposals
and no dramatic changes to prescriptions.

Even so,
knowing that someone's sleep at night might have improved a little,
or that someone's blood pressure in the rehab room might be stable tomorrow.
Those small signs of progress
are supported by those 3 minutes in the morning.

When I get home, it is time to be "Mom" again.
My 4-year-old daughter
does not yet really know that I am a "pharmacist." I think that is fine for now.

──What kind of time is your "3 minutes"?

Starting in June, I will begin a series writing about these clinical scenes one by one.
The title is "From the Front Lines of Rehab Pharmacy."

The 30-second conversations exchanged in the hallway,
the moments when I was stuck for an answer,
and still heading back up to the ward the next morning,
I will write about that repetition.

I would be happy if you read the articles again.

Recommended reading
▶ "Rehabilitation isn't progressing; the culprit might be 'medication'."

▶ What I kept thinking about after being told, "It's okay to stay in the pharmacy"